MEDICARE: DR. AURA S FUENTES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	4301114482	MI
2	208D00000X	General Practice Physician	ME155244	FL

General Provider Information

NPI Number	:	1932546546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AURA S FUENTES M.D.

Provider Business Mailing Address
First Line	:	4401 EMERSON ST STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-4954
Country	:	US
Telephone Number	:	904-399-8884
Fax Number	:	313-332-1857

Provider Business Practice Location Address
First Line	:	4401 EMERSON ST STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-4954
Country	:	US
Telephone Number	:	904-399-8884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	07/21/2023

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